MISSION TRIP APPLICATION FORMPlease complete and submit the form below after you have read the Mission Participant Expectations. All mission team members must complete and return the application in order to be eligible to serve. What mission trip/project are you applying for?(Required) What is the date of the mission trip/project?(Required) Have you already completed a BBC mission trip application in the last 18 months?(Required) No Yes Full Legal Name(Required)Please type your name as it appears on your driver's license and passport. First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Email(Required) Phone Number(Required) Gender(Required) Male Female Birthdate(Required) Passport Number (if applicable)Passport Date of Expiration T-Shirt Size EMERGENCY CONTACT INFORMATIONName of Emergency Contact(Required) First Last Relationship to Applicant(Required) .Emergency Contact Phone(Required) MEDICAL INFORMATIONDo you have any of these medical issues?(Required)Check all that apply. None Diabetes Fainting Spells Epilepsy Hepatitis High Blood Pressure Please describe any medical concerns your leader should be aware of:Have you ever been hospitalized? When and for what?Medications Allergies If under 18, please list the name of a legal guardian. First Last Insurance Carrier(Required) Policy Number(Required) Immunization HistoryPlease check all that apply. Diphtheria Measles Mumps Tetanus Polio Rubella Typhoid Hepatitis A Hepatitis B Immunization Consent(Required)If you answered no to any of the above, you or your legal guardian (if under 18) assumes all responsibility if an illness is contracted on the trip. I agree to the statements above.Medical Release & Consent(Required)In consideration for being allowed to participate in activities sponsored by Bartlett Baptist Church, I hereby release, discharge, indemnify, and agree to hold harmless Bartlett Baptist Church, its directors, officers, employees, and all volunteer personnel from any and all liability for personal injuries and/or damage(s), injury or illness that I may suffer. I further agree to indemnify and hold harmless Bartlett Baptist Church, its directors, officers, employees, agents, and all volunteer personnel for any claim and/or damages it, or its agents are required to pay as a result of any injury or damages including attorney fees, litigation expenses and court costs. I agree to the statements above.Digital Signature(Required) .Today's Date(Required) PERSONAL RESPONSE1. Describe briefly your salvation and baptism experience.(Required)2. Please describe your church involvement including attendance and places of service.(Required)3. What has brought you to a decision to participate in this mission trip?(Required)4. What is the estimated cost of the trip?(Required)5. How do you plan to fund this trip?(Required)6. What are some of your skills and passions?(Required)7. Does your family support you in the decision to participate in this missions project? If no, please explain.(Required)
